Managed care

Climbing on the national transparency bandwagon, BlueCross BlueShield of Tennessee has kicked off a program for enrollees that will let them know ahead of time what they'll owe for physician visits. The program affects only the roughly 64,000 of the plan's 1.2 million Tennessee members who are currently enrolled in its consumer-driven health plan.

Under the pilot program, physicians' offices will be able to use BlueCross billing software to make the estimate, which should take …

Blue Cross Blue Shield of Michigan has struck a partnership with 21 Michigan hospitals under which the group will work to better leverage coronary computed tomography angiography (CCTA). The idea is to see whether CCTA could someday replace the use of standard cardiac catheterization. In the past, the BCBS plan hadn't covered CCTA, but starting this month, hospitals participating in the program will be reimbursed for the test if they're part of the plan's PPO, Point of Service or Blue …

New research suggests that, at least in patients with chronic diseases, raising drug co-pays tends to cut drug use--but also raise the rate of patient hospitalizations and ED visits. The research, conducted by Dana Goldman, director of RAND Health's Bing Center on Health Economics, found that for every 10 percent increase in consumer cost-sharing, pharmacy spending drops 2 to 6 percent. However, in patients with conditions like congestive heart failure, high cholesterol, diabetes and …

Continuing with an ongoing industry-wide investigation, the California Department of Insurance has cited WellPoint subsidiary BC Life & Health for improperly revoking individual health insurance policies. BC Life & Health, which revoked 1,880 individual policies during 2004 and 2005, already was being sued by consumer advocates and lawyers for policyholders over the cancellations. Now it's facing the wrath of the Department of Insurance, which has found that more than half of the …

And the steamy plot gets thicker. A month after it kicked out Wall Street darling David Colby as CFO, WellPoint was named as a defendant in a suit accusing Colby of varied nasty misdeeds, including sexual battery.

Prior to his dismissal from WellPoint, Colby earned a $740,000 salary and had been awarded stock options worth about $1.7 million at the time. He's since sold $100 million plus of …

The California Department of Managed Health Care (DMHC) has issued a cease and desist order against UnitedHealthcare division PacifiCare of California, contending the health plan engaged in "dishonest and unfair" business practices. While the scale of the case is relatively small--it involves about 500 patients enrolled with a medical group in Redwood City--the matter is significant. It's only the second time in the DMHC's six-year history that it has issued such an order. What's …

Policy experts meeting at a Mayo Clinic-sponsored forum are recommending some significant changes to health plan reimbursement practices which they say could improve care and reduce costs. The experts, who met this week at Dartmouth, are suggesting that plans institute shared decision making programs for major elective surgery, in which medical centers are awarded bonuses for involving patients effectively. Another of their proposals is to develop a model for a single "chronic condition …

A large group of insurers has won a class-action suit alleging that it was delaying and denying payments inappropriately. Plaintiffs in the massive suit--which included not only more than a dozen individual physicians, but also the California Medical Association, Texas Medical Association, Medical Association of George, Florida Medical Association and Louisiana State Medical Society--had claimed that a group of plans used claims processing software to delay, cut back and refuse payment of …

Working with an outside information technology vendor, Blue Cross Blue Shield of Massachusetts has begun a program designed to identify patients whose care isn't meeting clinical guidelines. The vendor, MDdatacor, will analyze data from EMRs, transcribed office notes, lab results, and cross-reference that with the plan's pharmacy and claims data. BCBS plans to use the analysis as part of its pay-for-performance program. BCBS will begin by offering the tools to a subset of its physicians, …

The AMA has decided to go to war against insurers who impose fines on doctors if patients use out-of-network labs. While the dispute began with UnitedHealth Group, which has set plans in motion to impose such fines, the AMA is concerned enough about the trend that it is instituting a broader campaign opposing the institution of such fines by any insurer. The group is supporting …